Procedure-Prostatectomy

Procedure definition

A radical prostatectomy removes the prostate gland and seminal vesicles to treat localized prostate cancer. The goal is to eliminate cancer while preserving urinary control and sexual function when possible.

There are three main techniques:
• Robot-assisted laparoscopic prostatectomy (RALP): the most common approach, performed through 5–6 small incisions using robotic arms controlled by the surgeon.
• Traditional laparoscopic prostatectomy: similar but without robotic instruments.
• Open retropubic prostatectomy: a single lower-abdominal incision; now less common but still appropriate in select cases.

The operation takes 2–4 hours. The bladder is reattached to the urethra, and a catheter remains in place for about a week to allow healing.

Why it’s done

Surgery is offered for prostate cancer that is confined to the gland or surrounding tissue, usually in men expected to live at least 10 more years. It can be curative for most early-stage cancers.

In addition to removing cancer, surgery provides exact pathology to guide future care. In some cases, lymph nodes are also removed to check for spread. For men with more advanced disease, surgery may be part of a combined plan with radiation or hormone therapy.

Risks & complications

Overall major complication rate: 3–6%.
Mortality: <0.5%.

Common complications include:
• Urinary incontinence: Leakage requiring pads occurs in 5–30% of men at 12 months; most improve over time.
• Erectile dysfunction: Occurs in 30–70%, depending on age, baseline function, and nerve-sparing technique. Recovery may take 6–24 months.
• Bleeding needing transfusion: 1–3%.
• Infection or fever: 1–2%.
• Lymphocele (fluid collection): 1–3%.
• Rectal injury: <1%.
• Deep vein thrombosis: <1%.

Patients treated by high-volume urologic surgeons generally have better continence and sexual function outcomes due to refined nerve-sparing and reconstructive techniques.

Recovery

Hospital stay: 1–2 nights; catheter removed in 7–10 days.

Activity: Walking daily is encouraged immediately. Desk work in 2–3 weeks, heavy activity after 6 weeks.

Urinary recovery: Pelvic-floor (Kegel) exercises begin right after catheter removal. Continence typically improves over weeks to months.

Sexual recovery: Erections may return gradually over 6–24 months; medications like sildenafil or vacuum devices help restore function.

Diet: Normal diet within days; drink fluids to prevent infection.
Follow-up: PSA blood tests every 3–6 months initially to confirm cure.

Surgeon types

Performed by Urologic Oncologists or Urologists with specialized robotic or nerve-sparing training. Experience matters—surgeons performing >100 prostatectomies annually achieve superior cancer control and functional recovery.

Citations

1. American Urological Association (AUA): “After Prostate Surgery—Urinary and Sexual Recovery.”
2. NIH MedlinePlus: “Radical Prostatectomy.”
3. JAMA (2017): Comparative outcomes after surgery vs. radiation or observation.
4. European Urology (2020): Incontinence rates 5–30%; erectile dysfunction 30–70%.
5. Annals of Surgical Oncology (2021): Surgeon volume and functional outcomes.